Advertisement

Changes in E-Cigarette Perceptions Over Time: A National Youth Tobacco Survey Analysis

  • Joseph L. Rapp
    Affiliations
    Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York

    Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
    Search for articles by this author
  • Naomi Alpert
    Affiliations
    Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York

    Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
    Search for articles by this author
  • Karen M. Wilson
    Affiliations
    The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York

    Division of General Pediatrics, Icahn School of Medicine at Mount Sinai and Mount Sinai Kravis Children's Hospital, New York, New York
    Search for articles by this author
  • Raja M. Flores
    Affiliations
    Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
    Search for articles by this author
  • Emanuela Taioli
    Correspondence
    Address correspondence to: Emanuela Taioli, MD, PhD, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1133, New York, NY 10029.
    Affiliations
    Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York

    Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York

    The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York

    Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
    Search for articles by this author

      Introduction

      This multiyear, cross-sectional study explores the changes over time in how U.S. middle- and high-school students perceive the harm and addiction risk of E-cigarettes.

      Methods

      This study analyzed 83,779 participants in the National Youth Tobacco Survey from 2015 to 2019. Associations of survey year with perceived harm and addiction risk of E-cigarettes were assessed using multivariable multinomial logistic regression models, adjusted for sociodemographic characteristics.

      Results

      Smoking decreased over the 5 years (−1.85 percentage points, p=0.07); vaping increased (9.03 percentage points, p<0.01). Perceived harm of both combustible cigarettes and E-cigarettes increased with time. Male, older, and non-White students perceived less harm from smoking or vaping. Perceptions of the addictiveness of E-cigarettes increased over time: 26.31% of students considered E-cigarettes to be more addictive than combustible cigarettes in 2019, compared with 7.26% in 2016. Female and non-White students were more likely to think that E-cigarettes were at least as addictive as combustible cigarettes but also reported less knowledge about them.

      Conclusions

      The perceptions of both harm and addictiveness of E-cigarettes have increased over time, independent of current use. Perceptions vary on the basis of age, sex, race/ethnicity, and current use. Efforts should be made to further educate adolescents about E-cigarettes and to regulate their sale and advertisement. Efforts to reduce the uptake of combustible cigarettes among adolescents have been successful and should be duplicated for E-cigarettes.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Miech RA
        • Johnston LD
        • O'Malley PM
        • Bachman JG
        • Schulenberg JE
        • Patrick ME
        Monitoring the future national survey results on drug use, 1975−2018: 2018 volume I, secondary school students.
        Institute for Social Research, The University of Michigan, Ann Arbor, MIPublished June 2019 (Accessed April 6, 2021)
        • McMillen RC
        • Gottlieb MA
        • Shaefer RM
        • Winickoff JP
        • Klein JD.
        Trends in electronic cigarette use among U.S. adults: use is increasing in both smokers and nonsmokers.
        Nicotine Tob Res. 2015; 17: 1195-1202https://doi.org/10.1093/ntr/ntu213
        • Wang TW
        • Gentzke AS
        • Creamer MR
        • et al.
        Tobacco product use and associated factors among middle and high school students - United States, 2019.
        MMWR Surveill Summ. 2019; 68: 1-22https://doi.org/10.15585/mmwr.ss6812a1
        • Marynak KL
        • Gammon DG
        • Rogers T
        • Coats EM
        • Singh T
        • King BA.
        Sales of nicotine-containing electronic cigarette products: United States, 2015.
        Am J Public Health. 2017; 107: 702-705https://doi.org/10.2105/AJPH.2017.303660
        • Morean ME
        • Bold KW
        • Kong G
        • et al.
        Adolescents’ awareness of the nicotine strength and e-cigarette status of JUUL e-cigarettes.
        Drug Alcohol Depend. 2019; 204107512https://doi.org/10.1016/j.drugalcdep.2019.05.032
        • Kozlowski LT
        • Mehta NY
        • Sweeney CT
        • et al.
        Filter ventilation and nicotine content of tobacco in cigarettes from Canada, the United Kingdom, and the United States.
        Tob Control. 1998; 7: 369-375https://doi.org/10.1136/tc.7.4.369
        • Rapp JL
        • Alpert N
        • Flores RM
        • Taioli E.
        Serum cotinine levels and nicotine addiction potential of e-cigarettes: an NHANES analysis.
        Carcinogenesis. 2020; 41: 1454-1459https://doi.org/10.1093/carcin/bgaa015
        • Romberg AR
        • Miller Lo EJ
        • Cuccia AF
        • et al.
        Patterns of nicotine concentrations in electronic cigarettes sold in the United States, 2013-2018.
        Drug Alcohol Depend. 2019; 203: 1-7https://doi.org/10.1016/j.drugalcdep.2019.05.029
        • Bowen AX
        • Xing C
        • inventors
        • JUUL Labs, Inc, assignee
        Nicotine salt formulations for aerosol devices and methods thereof.
        U.S. patent. February 18, 2016; (20,160,044,967. Accessed January 21, 2021.)
        • Rao P
        • Liu J
        • Springer ML.
        JUUL and combusted cigarettes comparably impair endothelial function.
        Tob Regul Sci. 2020; 6: 30-37https://doi.org/10.18001/TRS.6.1.4
        • England LJ
        • Bunnell RE
        • Pechacek TF
        • Tong VT
        • McAfee TA.
        Nicotine and the developing human: a neglected element in the electronic cigarette debate.
        Am J Prev Med. 2015; 49: 286-293https://doi.org/10.1016/j.amepre.2015.01.015
        • Siqueira LM
        Committee on Substances Use and Prevention. Nicotine and tobacco as substances of abuse in children and adolescents.
        Pediatrics. 2017; 139e20163436https://doi.org/10.1542/peds.2016-3436
        • Chen J
        • Millar WJ.
        Age of smoking initiation: implications for quitting.
        Health Rep. 1998; 9: 39-48
        • Official Journal of the European Union
        Directive: directive 2014/40/EU of the European Parliament and of the Council of 3 April 2014 – on the approximation of the laws, regulations, and administrative provisions of the member states concerning the manufacture, and sale of tobacco and related products and repealing Directive 2001/37/EC..
        Official Journal of the European Union. Published April 29, 2014; (Brussels, Belgium.) (Accessed August 6, 2020.)
        • Walley SC
        • Wilson KM
        • Winickoff JP
        • Groner J.
        A public health crisis: electronic cigarettes, vape, and JUUL.
        Pediatrics. 2019; 143e20182741https://doi.org/10.1542/peds.2018-2741
        • Office on Smoking and Health
        2019 National Youth Tobacco Survey: methodology report.
        HHS, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GAPublished June 2019 (Accessed April 6, 2021)
        • McCoy SB
        • Gibbons FX
        • Reis TJ
        • Gerrard M
        • Luus CA
        • Sufka AV.
        Perceptions of smoking risk as a function of smoking status.
        J Behav Med. 1992; 15: 469-488https://doi.org/10.1007/BF00844942
        • Amrock SM
        • Zakhar J
        • Zhou S
        • Weitzman M.
        Perception of e-cigarette harm and its correlation with use among U.S. adolescents.
        Nicotine Tob Res. 2015; 17: 330-336https://doi.org/10.1093/ntr/ntu156
        • Kong G
        • Kuguru KE
        • Krishnan-Sarin S.
        Gender differences in U.S. adolescent e-cigarette use.
        Curr Addict Rep. 2017; 4: 422-430https://doi.org/10.1007/s40429-017-0176-5
        • HHS
        E-cigarette use among youth and young adults. a report of the Surgeon General.
        HHS, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GAPublished 2016 (Accessed April 6, 2021)
        • Grana RA
        • Ling PM.
        Smoking revolution”: a content analysis of electronic cigarette retail websites.
        Am J Prev Med. 2014; 46: 395-403https://doi.org/10.1016/j.amepre.2013.12.010
        • Simon P
        • Camenga DR
        • Morean ME
        • et al.
        Socioeconomic status and adolescent e-cigarette use: the mediating role of e-cigarette advertisement exposure.
        Prev Med. 2018; 112: 193-198https://doi.org/10.1016/j.ypmed.2018.04.019
        • Lee JG
        • Henriksen L
        • Rose SW
        • Moreland-Russell S
        • Ribisl KM.
        A systematic review of neighborhood disparities in point-of-sale tobacco marketing.
        Am J Public Health. 2015; 105: e8-e18https://doi.org/10.2105/AJPH.2015.302777
        • Dunbar MS
        • Martino SC
        • Setodji CM
        • Shadel WG.
        Exposure to the tobacco power wall increases adolescents’ willingness to use e-cigarettes in the future.
        Nicotine Tob Res. 2019; 21: 1429-1433https://doi.org/10.1093/ntr/nty112
        • Owotomo O
        • Maslowsky J.
        Adolescent smoking susceptibility in the current tobacco context: 2014−2016.
        Am J Health Behav. 2018; 42: 102-113https://doi.org/10.5993/AJHB.42.3.10
        • Sanders-Jackson A
        • Schleicher NC
        • Fortmann SP
        • Henriksen L.
        Effect of warning statements in e-cigarette advertisements: an experiment with young adults in the United States.
        Addiction. 2015; 110: 2015-2024https://doi.org/10.1111/add.12838
        • HHS, Food and Drug Administration, Center for Tobacco Products
        Enforcement priorities for electronic nicotine delivery systems (ENDS) and other deemed products on the market without premarket authorization (revised)*.
        HHS, Food and Drug Administration, Center for Tobacco Products, Rockville, MDPublished April 2020 (Accessed September 14, 2020.)
        • Moore G
        • Brown R
        • Page N
        • et al.
        Young people's use of e-cigarettes in Wales, England and Scotland before and after introduction of EU Tobacco Products Directive regulations: a mixed-method natural experimental evaluation.
        Int J Drug Policy. 2020; 85102795https://doi.org/10.1016/j.drugpo.2020.102795